Erc Als Lecture 2 Causes And Prevention

CAUSES AND PREVENTION OF CARDIORESPIRATORY ARREST

© Resuscitation Council (UK)

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Objectives To understand: • The causes of cardiorespiratory arrest • How to identify patients ‘at risk’ • The importance of preventing a cardiorespiratory arrest • The role of a Medical Emergency Team • The initial management of patients ‘at risk' of a cardiorespiratory arrest

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Outcome from in-hospital cardiac arrest VF / VT

429 31.4%

d rg e

D is ch a

R O

SC

6.2%

A rr es te d

rg ed

D is ch a

SC

42.2%

R O

400 200 0

939 68.6%

A rr es te d

1000 800 600

Non VF / VT

Gwinnutt C et al Resuscitation 2000;47: 125-135

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Care of the critically ill patient is frequently sub-optimal Confidential enquiry into ITU admissions • 40% admissions avoidable • 37% admissions occurred late • Lack of attention to

Airway, Breathing and Circulation McQuillan P et al BMJ 1998;316:1853-1858

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Sub-optimal care leads to cardiac arrest and poor outcome 30-70% patients who suffer a cardiorespiratory arrest in hospital have signs of physiological deterioration prior to the arrest

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ABCDE approach

A… B… C… D… E…

airway breathing circulation disability exposure

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Causes of cardiorespiratory arrest 1. Airway obstruction • • • • •

CNS depression Blood, vomit, foreign body Trauma Infection, inflammation Laryngospasm

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Airway obstruction • • • •

Symptoms and signs Difficulty breathing, distressed, choking Shortness of breath Stridor, wheeze, gurgling See-saw respiratory pattern

• • • •

Actions Oxygen Suction, positioning BLS manoeuvres Advanced airway intervention

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Causes of cardiorespiratory arrest 2. Breathing inadequacy •

• •

Pulmonary disorders infection – collapse – pneumothorax – asthma –

Decreased respiratory drive –

CNS depression

Decreased respiratory effort muscle weakness – restrictive chest defect –

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Breathing inadequacy • • • •

Symptoms and signs Short of breath, anxious, irritable Decrease in conscious level Tachypnoea Cyanosis

Action • Oxygen • Ventilatory support • Treat underlying cause where possible

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Causes of cardiorespiratory arrest 3. Cardiac abnormalities • • • • • •

Primary Ischaemia Myocardial infarction Hypertensive heart disease Valve disease Drugs Electrolyte abnormalities

• • • •

Secondary Asphyxia Hypoxaemia Blood loss Septic shock

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Circulatory / cardiac inadequacy • • • • •

Symptoms and signs Tachycardia Bradycardia Hypotension Poor perfusion (CRT) Poor cerebration Poor urine output

Action Oxygen • Fluids • Inotropes •

CRT = capillary refill time ERC

Disability / CNS abnormality

• • • •

Primary Trauma CVA Infection Poisons

Secondary • Hypoxia • Metabolic

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AVPU • • • •

A - alert V - responds to voice P - responds to pain U - unresponsive

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Disability / CNS abnormality Any CNS depression can lead to severe airway, breathing and circulatory problems

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Recognition of patients ‘at risk’ • History, examination, investigations • Clinical indicators of deterioration before in-hospital cardiorespiratory arrest in 80% – tachypnoea – tachycardia – hypotension – reduced conscious level

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Medical Emergency Team (MET) Example Calling Criteria • Airway threatened • Breathing – respiratory arrest – RR < 5 or RR >36 • Circulation – cardiac arrest – PR < 40 or PR >140 – systolic BP < 90

• Neurology – sudden fall in GCS > 2 • Any other concerns RR = respiratory rate PR = pulse rate ERC

Medical Emergency Team • Call team early • Empowers nursing staff and doctors to call for senior help • DNAR status may be clarified • Improved survival ERC

Any Questions ?

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Summary • Airway, breathing, circulatory or neurological problems can cause cardiorespiratory arrest • Patients often have warning symptoms and signs • Earlier recognition of patients ‘at risk’ may prevent cardiorespiratory arrest ERC